SURGERY. 



451 



lag it as often as possible over the compress. (See 

 plate LXXXVI. fig. 6.) About the third or fourth 

 day, the wound should be dressed with Turner's 

 cerate or adhesive plaster, according to its appear- 

 ance, and the compress and bandage re-applied; after- 

 wards, it ought to be dressed daily, and the com- 

 press and bandage worn for at least three or four 

 weeks, as aneurism or other unpleasant results 

 often supervene or follow this little operation. 

 Indeed, the cicatrix of the wounded artery is apt 

 to give way, and the blood to burst forth from 

 time to time, to the great inconvenience of the 

 patient ; and it is therefore necessary to obliterate 

 the cavity of the branch that was opened by con- 

 tinued pressure, or what is frequently done, namely, 

 dividing the artery entirely across at the place 

 where the wound was first made, after which, both 

 ends of it retract under the integuments, and the 

 cavity is quickly filled up, the discharge of blood 

 being commonly stopped in a moment by the 

 compression of the integuments under which the 

 divided vessel hides itself; or if this method 

 should prove ineffectual, it may be taken up with 

 a needle, and a ligature passed around it, as in the 

 case of a divided artery in amputation, or from any 

 other wound. These are operations that should, 

 however, be undertaken only by an adept in the 

 practice of surgery. There is no doubt but that 

 the opening of the temporal artery does great good 

 in inflammation of the brain or eye, especially when 

 the latter is very severe, and refuses to yield to 

 venesection. 



In addition to venesection and arteriotomy, there 

 are other modes of blood-letting employed in a 

 variety of cases, and these have been denominated 

 topical blood-letting, or local blood-letting ; and the 

 first of these in very general use we shall notice, 

 is cupping. The apparatus required for this opera- 

 tion are a scarificator, glass, cups, a spirit lamp or a 

 syringe. (See plate LXXXVII. figs. 2 and 19.) 

 The scarificator is an instrument moved with 

 springs, and containing from four to twenty lancets, 

 or more, according to the nature of the part to 

 which it is applied, or the quantity of blood it is 

 intended to draw away. A well constructed scari- 

 ficator, (and the instrument has of late been greatly 

 improved,) should be capable of being regulated so 

 as the lancets will only penetrate to such a depth 

 as may be required ; and there is considerable art 

 and dexterity required in the performance of this 

 little operation; so much so, as to have now ren- 

 dered it a separate branch of surgery in cities and 

 great towns. As there is, however, little danger 

 attendant on the operation, and it is one any per- 

 son with a few lessons may easily practise, if not 

 with all the dexterity and address of a professional 

 cupper, yet sufficiently well for all practical pur- 

 poses, we think it a branch of popular or domestic 

 surgery worthy of being cultivated ; indeed, a few 

 lessons from an expert operator, will render any 

 intelligent person competent to the performance of 

 the operation in the more ordinary parts of the 

 body in which it is employed. Previous to the ap- 

 plication of the scarificator, the cup or cups are 

 sometimes applied to the part, to draw blood in 

 greater abundance to the cuticular vessels. The 

 lancets are so placed in the scarificator, that they 

 may be made to cut in two directions. They must 

 be promptly raised during the transition of the 

 lancets from the one side to the other, to allow 

 them to move freely round ; and they should never 

 be sot to strike too deep, as they then completely 



divide the skin and reach the cellular tissue, the 

 blood vessels of which are not so large and numer- 

 ous, and, when wounded, pour their contents into 

 the cells. The scarificator being set, or its lancets 

 set to strike to the depth required, and the instru- 

 ment cocked by drawing back a lever on the upper 

 side, it is placed on the part by the slits down- 

 wards, and is discharged by pressing the nut of the 

 spring when the lancets make the incisions; and in 

 some cases it is necessary to strike twice with the 

 scarificator, crossing the wounds made by the first 

 stroke. The air in the cupping glass is then to be 

 exhausted, by introducing the flame of the spirit 

 lamp, or by burning a little tow or paper in the 

 glass, and applying it firmly and quickly above the 

 wounds made by the scarificator ; the cup will ad- 

 here, and blood will flow from the incisions; or 

 a syringe or stomach pump, in other words, a sim- 

 ple air pump, may be affixed to the cupping glass, 

 which is made for this purpose, and by placing the 

 mouth of the cup over the incisions, and working 

 the pump or syringe, the cup will firmly adhere, 

 and soon be filled with blood. (An example will 

 be seen in plate LXXXVII. fig. 20. which, how- 

 ever, is also the form of an instrument for emptying 

 the female breast.) Sometimes there is a cistern 

 attached to the lower part of the cupping glass, to 

 contain the blood, but in most cases it is not neces- 

 sary. When the cup is full, it may be removed, 

 emptied, and again applied. In either of these 

 ways, a considerable quantity of blood may be ob- 

 tained. When the requisite quantity has been with- 

 drawn, the part may be washed, and dried, and 

 some simple dressing, such as spermaceti ointment, 

 spread on a linen rag or caddis applied. Cupping 

 is a most valuable remedy in many diseases, and 

 in a great variety of cases preferable to leeches, 

 especially in affections of the spine and joints, while 

 it is neither a tedious or painful operation. 



Dry cupping is the application of cupping glasses 

 to a part, with a view of giving a determination of 

 blood to the surface, or leading it from the inter- 

 nal to the external parts. In the aged, or in those 

 cases where the abstraction of blood might prove 

 injurious in the end, did even blood-letting afford 

 a temporary relief, this mode is frequently em- 

 ployed. In such cases, the glasses or cups should 

 be larger ; very stout tumblers answer the purpose 

 very well; and the air is easily exhausted by a 

 spirit lamp, or moistening a very small slip of paper 

 in spirits, taking care not to use a greater quantity 

 of spirits than necessary, as the patient would 

 thereby be scalded with the hot liquor. 



In cases where no scarificator is to be procured, 

 blood may be drawn by making a number of scari- 

 fications with a lancet, and applying over them a 

 strong wine glass or a small stout tumbler, a prac- 

 tice often employed in domestic surgery with great 

 advantage. 



Scarification is used in violent inflammations of 

 the eye, and is the only other mode employed in 

 topical blood-letting, in which manual dexterity is 

 required. It is easily performed by first causing an 

 assistant secure the upper eye-lid ; then the opera- 

 tor, with the fingers of the left hand, secures the 

 under eye-lid, and, taking the lancet in the right 

 hand, makes a number of slight scarifications, in the 

 tunica conjunctiva of the eye, where Ihe vessels ap- 

 pear to be most turgid, and even a few drops of 

 blood, drawn in this manner, have afforded con- 

 siderable relief. 



Leeches arc likewise employed in topical blood- 



